scholarly journals How reliable is procalcitonin as an inflammatory marker?1)

2012 ◽  
Vol 35 (6) ◽  
pp. ---
Author(s):  
Katharina Biller ◽  
Peter Fae ◽  
Reinhard Germann ◽  
Autar K. Walli ◽  
Peter Fraunberger
Keyword(s):  
Intensive Care ◽  
Diagnostic Tool ◽  
Plasma Levels ◽  
Bacterial Infections ◽  
Respiratory Tract Infections ◽  
Inflammatory Marker ◽  
Antibiotic Use ◽  
Intensive Care Patients ◽  
Tract Infections

Abstract The role of procalcitonin (PCT) plasma levels as a diagnostic tool for intensive care patients has been intensively investigated during the past years. In particular for recognition of bacterial infections, PCT levels have been shown to be superior to other clinical and biochemical markers. Furthermore, some very recent studies show that in patients with lower respiratory tract infections PCT guided antibiotic therapy reduces antibiotic use and thereby may also reduce duration of stay of patients in hospital and thus cut hospitalisation costs. However, various studies indicate that the value of PCT as a prognostic marker is limited because of false positive or negative values. Despite these limitations PCT plasma levels are currently measured in intensive care units. The present study summarises the possible clinical uses of this laboratory marker as a diagnostic tool for the assessment of critically ill patients.

Improvement in detecting bacterial infection in lower respiratory tract infections using the Intensive Care Infection Score (ICIS)

2016 ◽  
Vol 40 (3) ◽  
Author(s):  
Martha Kaeslin ◽  
Saskia Brunner ◽  
Janine Raths ◽  
Andreas Huber
Keyword(s):  
Intensive Care ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Bacterial Infections ◽  
Respiratory Tract Infections ◽  
Hemoglobin Concentration ◽  
Potential Method ◽  
Lower Respiratory Tract Infections ◽  
Absolute Count ◽  
Tract Infections

AbstractImmediate treatment of lower respiratory tract infections (LRTI) caused by bacteria is important to reduce pneumonia and other complications such as systemic inflammatory response syndrome and sepsis. Nowadays procalcitonin (PCT) is the gold standard to differentiate between bacterial and non-bacterial infections in LRTI. The aim of this study was to evaluate if the new Intensive Care Infection Score (ICIS) which is a combination of various cellular measurements made on hematology analyzers could be a potential method to differentiate between bacterial and non-bacterial infections in LRTI.The ICIS is composed of five blood-cell derived parameters characterizing the early innate immune response; (1) mean fluorescence intensity of mature (segmented) neutrophils; (2) the difference in hemoglobin concentration between newly formed red blood cells and the mature ones; (3) absolute number of segmented neutrophils; (4) absolute count of antibody secreting lymphocytes and (5) absolute count of number of granulocytes.The discriminative power of ICIS to differentiate between patients with LRTI of bacterial and non-bacterial origin is as good or even better as the commonly used infection biomarkers PCT, CRP and IL-6.Beside PCT, CRP and IL-6, ICIS could be used as infection marker in LRTI.

scholarly journals Procalcitonin-Guided Antibiotic Therapy Reduces Antibiotic Use for Lower Respiratory Tract Infections in a United States Medical Center: Results of a Clinical Trial

2018 ◽  
Vol 5 (12) ◽  
Author(s):  
Jennifer Townsend ◽  
Victoria Adams ◽  
Panagis Galiatsatos ◽  
David Pearse ◽  
Hardin Pantle ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antibiotic Therapy ◽  
Respiratory Tract Infections ◽  
Antibiotic Use ◽  
Adverse Outcomes ◽  
Control Group ◽  
Lower Respiratory Tract Infections ◽  
Antibiotic Duration ◽  
Tract Infections

Abstract Background European trials using procalcitonin (PCT)-guided antibiotic therapy for patients with lower respiratory tract infections (LRTIs) have demonstrated significant reductions in antibiotic use without increasing adverse outcomes. Few studies have examined PCT for LRTIs in the United States. Methods In this study, we evaluated whether a PCT algorithm would reduce antibiotic exposure in patients with LRTI in a US hospital. We conducted a controlled pre-post trial comparing an intervention group of PCT-guided antibiotic therapy to a control group of usual care. Consecutive patients admitted to medicine services and receiving antibiotics for LRTI were enrolled in the intervention. Providers were encouraged to discontinue antibiotics according to a PCT algorithm. Control patients were similar patients admitted before the intervention. Results The primary endpoint was median antibiotic duration. Overall adverse outcomes at 30 days comprised death, transfer to an intensive care unit, antibiotic side effects, Clostridium difficile infection, disease-specific complications, and post-discharge antibiotic prescription for LRTI. One hundred seventy-four intervention patients and 200 controls were enrolled. Providers complied with the PCT algorithm in 75% of encounters. Procalcitonin-guided therapy reduced median antibiotic duration for pneumonia from 7 days to 6 (P = .045) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) from 4 days to 3 (P = .01). There was no difference in the rate of adverse outcomes in the PCT and control groups. Conclusions A PCT-guided algorithm safely reduced the duration of antibiotics for treating LRTI. Utilization of a PCT algorithm may aid antibiotic stewardship efforts. This clinical trial was a single-center, controlled, pre-post study of PCT-guided antibiotic therapy for LRTI. The intervention (incorporation of PCT-guided algorithms) started on April 1, 2017: the preintervention (control group) comprised patients admitted from November 1, 2016 to April 16, 2017, and the postintervention group comprised patients admitted from April 17, 2017 to November 29, 2017 (Supplementary Figure 1). The study comprised patients admitted to the internal medicine services to a medical ward, the Medical Intensive Care Unit (MICU), the Cardiac Intensive Care Unit (CICU), or the Progressive Care Unit (PCU) “step down unit”. The registration data for the trails are in the ClinicalTrials.gov database, number NCT0310910.

scholarly journals Potential role of adjuvant micronutrient therapy in the management of respiratory tract infections: a narrative review

2021 ◽  
Vol 11 (1) ◽  
pp. 74
Author(s):  
Pratyusha P. Gaonkar ◽  
Vinay Purohit
Keyword(s):  
Immune System ◽  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Common Knowledge ◽  
Antibiotic Use ◽  
Global Issue ◽  
Considerable Morbidity ◽  
Micronutrient Therapy ◽  
Tract Infections

Respiratory tract infections (RTIs) are highly prevalent and variable in nature, and are accountable for considerable morbidity and mortality. Acute respiratory tract infections (ARIs) are the third leading cause of death worldwide and the most common cause of antibiotic prescription among adults. It is common knowledge that inappropriate or overuse of antibiotics for RTIs is a crucial contributing factor with respect to the emergence of microbes that are resistant to the drug’s effects. Overuse of antibiotics and antibiotic resistance is a global issue that is becoming a serious concern. There is a growing need for novel approaches and adjuvant therapies for such infections, particularly in the setting of worsening antibacterial resistance. The strategy of supporting the immune system of the host in advance of infection exposure would decrease the number and severity of infections and thus decrease antibiotic use. Micronutrients have varied roles throughout every stage of the immune system and help in strengthening and maintaining immune function. Deficiencies of micronutrients are associated with varied health outcomes and can impact both innate and adaptive immunity profoundly, causing immunosuppression and thus leading to increased susceptibility to infections. Moreover, in view of the COVID-19 pandemic situation, the factors that help the proper functioning of the immune system have garnered much interest and hence the maintenance of an optimal status of certain micronutrients could be particularly beneficial.

scholarly journals Clinical symptoms and treatment of common respiratory tract infections in relation to microbiological profiles in rural health facilities in China: implications for antibiotic stewardship

2020 ◽  
Author(s):  
Xingrong Shen ◽  
Jilu Shen ◽  
Yaping Pan ◽  
Jing Cheng ◽  
Jing Chai ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Antibiotic Stewardship ◽  
Bacterial Infections ◽  
Respiratory Tract Infections ◽  
Clinical Symptoms ◽  
Rural China ◽  
Clinical Manifestations ◽  
Antibiotic Use ◽  
Presenting Symptoms ◽  
Tract Infections

Abstract Background: This study aims to identify the extent to which current clinical practice in the treatment of common respiratory tract infections (RTIs) is consistent with presenting symptoms and microbiological characteristics at health care settings in rural China and implications for future antibiotic stewardship.Methods: The study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. Observations, structured and semi-structured interviews were conducted to investigate antibiotic use. Sputum and throat swabs were collected for bacterial culture and susceptibility testing.Results: A total of 1068 completed the study. Antibiotics were prescribed for 87.8% of RTI patients. Of all the specimens tested, 329 (30.8%) specimens were isolated with bacteria. The most frequently detected bacteria were K. pneumonia (24.15% in all specimens), H. influenza (16.19%), H. parainfluenzae (14.77%), S.aureus (5.11%), M. catarrhalis (3.41%) and S. pneumoniae (2.27%). The bacteria detection was associated with age (OR=1.91), season (OR=0.41 to 0.60), days since infection onset (OR=1.54 to 1.81), and runny or blocked nose (OR=1.39 to 1.61), cough with green or white sputum (OR=1.47 to 1.59). Antibiotic use was only linked with limited non-specific clinical manifestations e.g., days since infection onset (OR=0.53) and sore throat (OR=1.64).Conclusions: The study reveals that antibiotics prescription is still very common in rural China which is driven mainly by non-pathological factors rather than treatment of bacterial infections. The study establishes the feasibility of conducting microbiological testing outside Tier 2 and 3 hospitals in rural China.

scholarly journals Role of CRP in Lower Respiratory Tract Infections

2013 ◽  
Vol 33 (2) ◽  
pp. 117-120
Author(s):  
Jaskaranjot Kaur ◽  
Gursharan Singh Narang ◽  
Sunita Arora
Keyword(s):  
Respiratory Tract Infections ◽  
Acute Phase Protein ◽  
Rapid Determination ◽  
Antibiotic Use ◽  
Lower Respiratory Tract Infections ◽  
Viral Aetiology ◽  
Bacterial Aetiology ◽  
Tract Infections

Introduction: Better diagnostic tests that establish the cause of LRTIs can reduce irrational antibiotic use. CRP is an acute phase protein that increases on inflammatory triggers can solve the purpose. The study aimed at role of CRP in distinguishing between bacterial and viral etiology. Materials and Methods: Fifty patients, aged 2 months to 5 years, with complaints of fever, cough and respiratory distress were included. Along with all other basic investigations like CBC, PBF, ESR, CRP Quantitative was also by Nycocard CRP Single Test for in vitro rapid determination. Results: In LRTI of probable bacterial aetiology mean CRP was 61.72 ±36.665 mg/l which was significantly higher than those with probable viral aetiology with mean CRP of 5.24 ±1.4 mg/l. The cut off level of CRP is taken as 9 mg/l with sensitivity of 100% and specificity of 96 %. Conclusion: CRP levels are both sensitive and specific for differentiating between viral and bacterial LRTI, thus reducing the overuse of antibiotics in clinical practice. DOI: http://dx.doi.org/10.3126/jnps.v33i2.8106   J Nepal Paediatr Soc. 2013; 33(2):117-120

scholarly journals Clinical symptoms and treatment of common respiratory tract infections in relation to microbiological profiles in rural health facilities in China: implications for antibiotic stewardship

2020 ◽  
Author(s):  
Xingrong Shen ◽  
Jilu Shen ◽  
Yaping Pan ◽  
Jing Cheng ◽  
Jing Chai ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Antibiotic Stewardship ◽  
Bacterial Infections ◽  
Respiratory Tract Infections ◽  
Rural China ◽  
Clinical Manifestations ◽  
Antibiotic Use ◽  
Anhui Province ◽  
Presenting Symptoms ◽  
Tract Infections

Abstract Background This study aims to identify the extent to which current clinical practice in the treatment of common respiratory tract infections (RTIs) is consistent with presenting symptoms and microbiological characteristics at health care settings in rural Anhui Province and implications for future antibiotic stewardship. Methods The study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. Observations, structured and semi-structured interviews in village clinics and township health centers were conducted to investigate antibiotic use. Sputum and throat swabs were collected for bacterial culture and susceptibility testing. Results A total of 1068 (51.0% males and 49.0% females) completed the study. Antibiotics were prescribed for 87.8% of RTI patients. Of all the specimens tested, 329 (30.8%) specimens were isolated with bacteria. The most frequently detected bacteria were K. pneumonia (24.15% in all specimens), H. influenza (16.19%), H. parainfluenzae (14.77%), S.aureus (5.11%), M. catarrhalis (3.41%) and S. pneumoniae (2.27%). The bacteria detection was associated with age (OR = 1.91), season (OR = 0.41 to 0.60), days since infection onset (OR = 1.54 to 1.81), and runny or blocked nose (OR = 1.39 to 1.61), cough with green or white sputum (OR = 1.47 to 1.59). Antibiotic use was only linked with limited non-specific clinical manifestations e.g., days since infection onset (OR = 0.53) and sore throat (OR = 1.64). Conclusions The study reveals that antibiotics prescription is still very common in rural China which is driven mainly by patient reassurance and other non-pathological factors rather than treatment of bacterial infections. The study establishes the feasibility of conducting microbiological testing outside Tier 2 and 3 hospitals in rural China.

scholarly journals Clinical Symptoms and Treatment of Common Respiratory Tract Infections in Relation to Microbiological Profiles in Rural Health Facilities in China: Implications for Antibiotic Stewardship

2020 ◽  
Author(s):  
Xingrong Shen ◽  
Jilu Shen ◽  
Yaping Pan ◽  
Jing Cheng ◽  
Jing Chai ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Antibiotic Stewardship ◽  
Bacterial Infections ◽  
Respiratory Tract Infections ◽  
Clinical Symptoms ◽  
Rural China ◽  
Clinical Manifestations ◽  
Antibiotic Use ◽  
Presenting Symptoms ◽  
Tract Infections

Abstract Background This study aims to identify the extent to which current clinical practice in the treatment of common respiratory tract infections (RTIs) is consistent with presenting symptoms and microbiological characteristics at health care settings in rural China and implications for future antibiotic stewardship.Methods The study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. Observations, structured and semi-structured interviews were conducted to investigate antibiotic use. Sputum and throat swabs were collected for bacterial culture and susceptibility testing.Results A total of 1068 completed the study. Antibiotics were prescribed for 87.8% of RTI patients. Of all the specimens tested, 329 (30.8%) specimens were isolated with bacteria. The most frequently detected bacteria were K. pneumonia (24.15% in all specimens), H. influenza (16.19%), H. parainfluenzae (14.77%), S.aureus (5.11%), M. catarrhalis (3.41%) and S. pneumoniae (2.27%). The bacteria detection was associated with age (OR=1.91), season (OR=0.41 to 0.60), days since infection onset (OR=1.54 to 1.81), and runny or blocked nose (OR=1.39 to 1.61), cough with green or white sputum (OR=1.47 to 1.59). Antibiotic use was only linked with limited non-specific clinical manifestations e.g., days since infection onset (OR=0.53) and sore throat (OR=1.64).Conclusions The study reveals that antibiotics prescription is still very common in rural China which is driven mainly by non-pathological factors rather than treatment of bacterial infections. The study establishes the feasibility of conducting microbiological testing outside Tier 2 and 3 hospitals in rural China.

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